Briana Contreras

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Falls are the current leading cause of injuries for older Americans, and many of them result in permanent disability and fatalities. The risk of falling for older adults doubles 

if they have impaired vision from a degenerative eye disease like diabetic retinopathy.

In the midst of the COVID-19 pandemic, more older adults are living independently. This makes it even more crucial of a time to be focusing on vision care and, more importantly, on care toward diabetic retinopathy. Not to mention, 

November celebrates National Eye Disease Awareness Month.

Degenerative eye issues are conditions that can develop from ultraviolet radiation, from aging or from other health conditions that impact eyesight, such as diabetic retinopathy, cataracts, glaucoma and age-related macular degeneration. For example, age-related macular degeneration and glaucoma are the leading causes of vision loss of people over 50, while diabetic retinopathy and cataracts can be caused by the impact of diabetes on blood sugar and blood vessels in the eyes, says Dr. Mark Ruchman, chief medical officer at Versant Health.

Eyesight changes due to aging are inevitable, and the risk of systemic disease increases as people grow older. However, there are simple preventative measures that aging people, particularly those living with diabetes, can take to protect their eyesight, reduce their risk of vision loss and enjoy the wonders of healthy vision, says Ruchman.

The single most important preventative measure against degenerative eye diseases like diabetic retinopathy, which can be costly to both patients and managed care plans, is access to regular eye exams that can detect vision—and other health issues—early and allow for immediate intervention, he says. 

"Twenty percent of people first learn that they are diabetic as a result of an eye exam when the eye doctor examines the optic nerve, retinal blood vessels and the back of the eye for the telltale signs of the disease," Ruchman says. "Nearly 30% of diabetics suffer from diabetic retinopathy, and in the senior population, this can impact quality of life by increasing the risk for dangerous, and even fatal, falls. A regular eye exam is a critical component of any health and wellness program to reduce blindness from this disease. And yet, even with the threat of blindness, research shows that many diabetics skip their annual eye exam."

In addition, while diabetic retinopathy is specific to the eye, the vascular changes that occur with the eye disease are present throughout the body. If abnormal blood vessels are found in the eye, it's possible the disease has also affected the kidneys, skin, brain, heart, etc., with the significant multisystem morbidity that this would imply. In addition, visual loss exacerbates all functions of quality of life especially depression in the elderly, Ruchman adds.

Regular eye exams for all ages are encouraged, of course. Although, through 

a managed vision care plan that serves as a guide for eye health, aging adults can make lifestyle changes that not only prevent degenerative eye diseases like as diabetic retinopathy, but also manage their whole body health, as eye health and overall health are closely linked.

Prevention also includes quitting smoking. People who smoke have a have a higher risk of developing degenerative eye diseases. Aging adults should also consider taking steps to maintain a healthy weight, as research suggests that people who are overweight are more likely to develop conditions like cataracts and glaucoma.

According to Ruchman, early prevention can also help financially.

"By the age of 65, one in every three individuals has some form of vision-reducing eye disease, and having impaired vision more than doubles the risk of falls for seniors, which can be costly for health plans, their members and families," he says. "Each year about $50 billion is spent on non-fatal fall injuries and $754 million is spent on fatal falls. Improving seniors’ access to vision care, including eye exams that test visual acuity, is an easy and cost-effective solution to protect vision and overall health, minimize human suffering and mitigate the financial impact of falls among the elderly. Timely intervention for degenerative diseases, such as diabetic retinopathy, cataracts and glaucoma, can preserve vision and reduce the likelihood of falls."

Articles

Falls are the current leading cause of injuries for older Americans, and many of them result in permanent disability and fatalities. The risk of falling for older adults doubles if they have impaired vision from a degenerative eye disease like diabetic retinopathy.





Impact of Vision Care, Specifically Diabetic Retinopathy, on Older Adults 

Jennifer Tryon, Pharm.D., M.S., FASHP, associate vice president and chief pharmacy officer, Wake Forest Baptist Health, Winston-Salem, North Carolina; residency program director for the Health System Pharmacy Administration and Leadership Residency Program

I grew up in Western Europe and came to the United States when I was 18 to pursue a pharmacy degree from the University of Iowa and a master’s of science from the University of Wisconsin. I went on to complete a two-year administrative residency at University of Wisconsin Hospitals and Clinics.

I took a job as the assistant director at Oregon Health & Sciences University and then became the assistant director of pharmacy and residency program director at PeaceHealth Southwest Medical Center in Vancouver, Washington. I also served as the chief pharmacy officer at the University of Chicago Medical Center and as the director of graduate pharmacy education there.

When I was growing up, my parents introduced me to the importance of having a liberal arts approach to life. I had a passion for leadership and helping others and an interest in the arts and sciences. I sought a profession where I could apply my diverse interests in service to others. The pharmacy profession allows me to work with talented teammates on innovative models of care, with a focus on improving services to our communities.

What has been your biggest learning experience in the industry? What did it teach you?

I’ve learned the importance of teamwork and collaboration in achieving success. Collectively, we can leverage our different skill sets, ideas and energy to create services that would otherwise not have been possible.

How has COVID-19 affected your responsibilities and how your organization operates? How might your job and your organization change because of the pandemic?

COVID-19 has impacted the manner in which our teams interact, especially as it pertains to introducing virtual platforms. There is a silver lining that the pandemic has afforded our organization in that we have ensured patient access to pharmacy services by leveraging telehealth platforms, expanding our population health platforms for community outreach to high risk patients, and introducing drone delivery of medications and equipment. I am proud to work for an organization that fosters innovation in care models.

How has the current discussion of racism and healthcare inequity affected you, your outlook and your organization? What has been the short-term response, and what do you envision happening over the longer term to your organization and American healthcare?

In the short term, we are creating awareness by providing forums to learn about racial inequalities and share our thoughts and emotions. The challenge I see before us is how we can move from awareness to actions aimed at decreasing racial disparities and ensuring all patients have the essentials; for example, housing, food and healthcare. This movement requires leadership and a commitment to study and address gaps in how we care for those we serve.

We cannot deliver on our mission of patient-centered care if we aren’t addressing racism and the impact of race on healthcare. This begins with an understanding of the health inequities specific to the Black community served by our health system so we can work to address them. As leaders and healthcare professionals, we are in positions of incredible influence in our community, and we have a responsibility to ensure that we leverage the opportunity to be and do better.

What other kinds of changes do you expect to see in healthcare in the next five to 10 years?

I expect to see medications become increasingly specialized and expensive. We need better methods to ensure affordability and access to care for patients. I also think healthcare will increasingly move to care in the home.

An area for healthcare to embrace is technology advancement and machine learning. This will present an opportunity to redeploy healthcare professionals to areas like primary care and geriatrics where patient needs are growing.

What have you enjoyed about social distancing and extra stay-at-home time during the past few months?

I have also enjoyed seeing my team flourish without us being together every day. It has been rewarding to see great progress even though we were working remotely.

Managed Healthcare Executive's October issue headlines 10 healthcare leaders in its fourth annual "10 Emerging Industry Leaders" feature. MHE spotlights each leader individually with a Q&A interview between MHE and the emerging leader.



10 Emerging Industry Leaders: Jennifer Tryon

There is some anticipation and uncertainty had over the new 

Interoperability and Patient Access final rule (9115-F)

Centers for Medicare and Medicaid Services (CMS)

 will be releasing in January. This new guideline is aimed to empower patients and improve interoperability while reducing the burden on payers and providers. However, the process to meet the requirements will be challenging, according to 

Don Woodlock, vice president of Healthcare Solutions at InterSystems, 

a global data platform provider that supports over 1 billion patient records.

True interoperability has been a major goal of the U.S. healthcare industry for more than a decade, Woodlock says.

In 2009, Congress passed the HITECH (Health Information Technology for Economic and Clinical Health) Act to encourage the adoption of electronic health records (EHRs) and supporting technology across the country, while improving the safety, quality, and efficiency of patient care. However, this goal has yet to be obtained, he adds.

The new Interoperability and Patient Access final rule put forward by CMS is an effort to improving overall interoperability, which is the exchange of healthcare data between providers, payers, and patients. This outcome will be achieved by freeing up patient data through CMS’s authority over Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). Most importantly, the CMS final rule empowers patients by giving them greater access to their health information so that they can use it effectively in their own care. The first requirements of the federal guideline will go into effect in January 2021.

While efforts have been on-going for years to provide further access to health information and create a smoother process in delivering care, COVID-19 helped expose the lack of interoperability in the U.S. healthcare system, underscoring the need for payers, providers and federal agencies like CMS to work together to obtain greater access to healthcare data, Woodlock says.

Guidelines proven to be needed for interoperability may face some challenges in the process to meet the requirements, though. 

The CMS final rule will roll out new standards and guidelines over the next two years, but there are two standards-based application programming interfaces (APIs)—the Patient Access API and Provider Directory API—that will prove to be the most challenging for organizations to meet, 

"Part of the immediate challenge is that the implementation guides on how to actually address clinical data format and access needs have yet to be finalized," 

 "Taking incoming data from different sources and placing it into a standardized format can be especially difficult because there is a range of complex terminologies that must be navigated in order to complete the conversion into Fast Healthcare Interoperability Resources (FHIR). In addition, the CMS rule requires that provider directory data must be available to the public through standards-based APIs, which can be challenging, particularly if expertise and time are in short supply."

tight timelines of the new CMS rule, organizations should partner with experienced HIT vendors that have the expertise to transform data into FHIR to make it accessible and ensure the tools being used align with the privacy, security, and safety needs of the organization and membership. HIT vendors can also help organizations work towards greater interoperability by aggregating, normalizing and deduplicating data across multiple systems so that organizations can use it effectively.

One of the challenges with the clinical data requirement of the Patient Access APIs is that it puts forward a variety of brand new data types such as vital signs data collected by payers that don’t use a standard set of terminology, he says. Leveraging the experience of an HIT vendor from the provider and clinical side of the business can help payers get this data aggregated quickly and efficiently.

At InterSystems, they are helping customers meet the new guidelines with their HealthShare® CMS Solution Pack™. The Solution Pack leverages InterSystems expertise in interoperability and bundles together solutions, including technology, hosting, focused implementation and pricing solutions, all geared towards helping organizations meet the obligations of the new CMS rules as quickly and painlessly as possible. 

CMS's new Interoperability and Patient Access final rule (9115-F)they will be releasing in January is aimed to empower patients and improve interoperability while reducing the burden on payers and providers. However, the process to meet the requirements will be challenging.

The Impact New CMS Guidelines Could Have on Interoperability, Patient Care

Efrain Talamantes, M.D., MBA, MSHPM, chief operating officer, AltaMed Health Services,
Los Angeles

I grew up as the oldest of three children in Norwalk, California. My parents were raised in a rural farming community in Jalisco, Mexico, and immigrated to the United States in search of a better future. From poverty to lack of access to healthcare, the many experiences we faced as immigrants shaped my passion to improve others’ health and well-being. I credit my family, friends, teachers, mentors and outreach programs that recognized my potential and never allowed me to give up.

I earned a B.S. in psychobiology at UCLA, an M.D. at David Geffen School of Medicine at UCLA, an MBA at Emory University, and an M.S. in health policy and management at the UCLA Fielding School of Public Health. Next, I had a residency at the University of California, Davis (UC Davis). I also completed the prestigious Robert Wood Johnson Foundation Clinical Scholars Program at UCLA and was recognized by the Society of General Internal Medicine with the Mack Lipkin Sr. Associate Award for my research, “Community College Pathways: Improving the U.S. Physician Workforce Pipeline.”

After my fellowship, I served as the inaugural medical director for the hospital medicine department, and I helped open Martin Luther King Jr. Community Hospital in Los Angeles. I then served as the associate director for the UC Davis Center for Reducing Health Disparities and co-directed the Center for a Diverse Healthcare Workforce.

Today, I serve on the executive physician leadership team at AltaMed and as the medical director for the AltaMed Institute for Health Equity, leading research, innovative health delivery, and training programs that address disparities affecting our patients. Under my leadership, AltaMed received its first Patient-Centered Outcomes Research Institute grant to develop the Health Equity to Advance Latino Patient-Centered Research community advisory board. I also serve as the designated institutional officer for AltaMed’s inaugural family medicine residency program.

My interest in medicine was fueled by interpreting for my parents in the hospital. I experienced how cultural and language barriers impact quality of care. I combined my passion for science and serving my community by pursuing medicine with the help of mentors and my family.

The healthcare industry has trailed behind in embracing people of color in leadership. I’ve learned that my patients and colleagues benefit from my partnership in solving some of today’s most pressing challenges. If we co-design our healthcare delivery system with underrepresented groups in mind, we can improve the health of those who suffer most. I also dedicate a lot of time to mentoring students who come from underrepresented backgrounds.

Thepandemic has shown how fragmented our system is when serving theunderinsured. During the pandemic, AltaMed re-imagined healthcare by providing access to COVID-19 testing in underserved communities, scaled access to telehealth and invested in our workforce’s well-being.

We held a town hall for 8:46 minutes in remembrance, where many of us kneeled for George Floyd and Black lives lost to violence. We held a panel discussing AltaMed’s position on law enforcement violence and racism as a public health crisis. We’re working on anti-racism initiatives to improve health outcomes for people of color.

What other kinds of changes do you expect to see in healthcare in the next 5 to 10 years?

I expect to see us find better ways to care for people in their homes using technology. My goal is to ensure that access to these programs will be equitable. I also expect to see health equity play a more central role in how we design healthcare delivery.

I’ve had the chance to rediscover how fun it is to play hide-and-seek with my children and how important these straightforward games are to bonding. I have yet to find the best hiding place in our home, as my daughter always finds me and my son.

Managed Healthcare Executive's October issue headlines 10 healthcare leaders in its fourth annual "10 Emerging Industry Leaders" feature. MHE spotlights each leader individually with a video interview to accompany the Q&A between MHE and the emerging leader.



Author | Briana Contreras

Articles

Impact of Vision Care, Specifically Diabetic Retinopathy, on Older Adults

10 Emerging Industry Leaders: Jennifer Tryon

The Impact New CMS Guidelines Could Have on Interoperability, Patient Care

10 Emerging Industry Leaders: Efrain Talamantes